Safety and Efficacy of Adalimumab for Patients With Moderate to Severe Crohn`s Disease: The Taiwan Society of Inflammatory Bowel Disease (TSIBD) Study

( Chen Wang Chang ),( Shu Chen Wei ),( Jen Wei Chou ),( Tzu Chi Hsu ),( Chiao Hsiung Chuang ),( Ching Pin Lin ),( Wen Hung Hsu ),( Hsu Heng Yen ),( Jen Kou Lin ),( Yi Jen Fang ),( Horng Yuan Wang ),( 대한장연구학회 2014 Intestinal Research Vol.12 No.4

Background/Aims: Only moderate to severe Crohn`s Disease (CD) patients without a satisfactory conventional therapy effect are eligible to get reimbursement from the National Health Insurance of Taiwan for using adalimumab. These are more stringent criteria than in many Western countries and Japan and Korea. We aim to explore the efficacy of using adalimumab in CD patients under such stringent criteria. Methods: A retrospective analysis was conducted in nine medical centers in Taiwan and we collected the results of CD patients receiving adalimumab from Sep 2009 to Mar 2014. The clinical characteristics, response measured by CDAI (Crohn`s Disease Activity Index), adverse events and survival status were recorded and analyzed. CR-70, CR-100, and CR-150 were defined as attaining a CDAI decrease of 70, 100 or 150 points compared with baseline. Results: A total of 103 CD patient records were used in this study. Sixty percent of these patients received combination therapy of adalimumab together with immunomodulators. CR-70 was 68.7%, 74.5% and 88.4% after week 4, 8 and 12 of treatment, respectively. The steroid-free rate, complications and survival were 47.6%, 9.7% and 99% of patients, respectively. In considering the mucosal healing, only 25% patients achieve mucosal healing after treatment for 6 to12 months. Surgery was still needed in 16.5% of patients. Combination treatment of adalimumab with immunomodulators further decreased the level of CDAI at week 8 when compared with the monotherapy. Conclusions: Even under the stringent criteria for using adalimumab, the response rate was comparable to those without stringent criteria. (Intest Res 2014;12:287-292)

Anti-fatigue activity of dripped spent hens chicken essence in ICR mice

Chang Ti Chun,Chen Wei Cheng,Huang Chao Wei,Lin Liang Chuan,Lin Jen Shinn,Cheng Fu Yuan 아세아·태평양축산학회 2023 Animal Bioscience Vol.36 No.2

Objective: Chicken essence and branched chain amino acid (BCAA) supplementation has been recognized to significantly relieve fatigue. To obtain chicken essence with high amounts of BCAA, spent hens herein was used to prepare dripped chicken essence (SCE) and compared with commercial dripped chicken essence (CCE) for in vivo anti-fatigue effect. Methods: To determine the effect on anti-fatigue by dripped chicken essence, the exhaustive swimming was performed. Thirty-two 7-week ICR mice were divided into four groups, which included the control group (CG), CCE, SCE-1X and SCE-2X. The mice were given daily oral administration (0.012 mL/g body weight/d). The fatigue index analysis was conducted weekly. Results: The results showed that SCE had a higher BCAA level as expected, and mice treated with dripped chicken essence (CCE and SCE) could significantly improve exercise performance. The lower blood lactate level, blood urea nitrogen level and creatine phosphokinase activity were found in the supplement of SCE group compared with the CCE group, which suggested that the SCE possessed strong anti-fatigue ability. This could possibly be due to the higher content of BCAA. Conclusion: In this study, SCE promoted recovery from physical fatigue in mice and elevated endurance ability. Among them, the double dose (SCE-2X) showed the strongest antifatigue ability. Taken together, spent chickens could be a good source of chicken essence to improve the effect of anti-fatigue.

IL-33/ST2 axis mediates hyperplasia of intrarenal urothelium in obstructive renal injury

Wei-Yu Chen,Jenq-Lin Yan,Yi-Hsiu Wu,Lung-Chih Li,Ru-Fang Li,Ya-Ting Chang,Lo-Hsin Dai,Wan-Chen Wang,Ya-Jen Chang 생화학분자생물학회 2018 Experimental and molecular medicine Vol.50 No.-

The monolayered intrarenal urothelium covers the renal papilla and ureteropelvic junction (UPJ). In response to increased renal pressure during obstruction or ischemic injuries, intrarenal urothelial cells begin to proliferate and form a multilayered urothelium. Little is known regarding the mechanism and pathophysiological role of urothelium hyperplasia during renal obstruction. In this study, we investigated the expression of interleukin (IL)-33, an IL-1 family cytokine, in kidneys with unilateral ureteral obstruction (UUO)-induced obstructive injury. IL-33 levels in hydronephrotic urine and serum were upregulated 2 days after UUO. The number of ST2-expressing immune cells was increased in the UUO kidney. We found that IL-33 was upregulated in vimentin-positive cells in the cortical and medullar layers and the UPJ stroma. Moreover, IL-33 expression was predominantly induced in multilayered keratin 5- positive urothelial cells in the UPJ. IL-33 was not detected in terminally differentiated superficial umbrella cells expressing uroplakin 3a. In vivo, we confirmed that deficiency of IL33 or its receptor ST2 attenuated UUO-induced hyperplasia of the UPJ urothelium. Deficiency of IL33 attenuated the expression of UUO-induced type 2 inflammatory cytokines and upregulated uroplakins and urothelial differentiation signaling in UPJ tissues. Our results collectively suggest that the IL-33/ST2 axis mediates the activation of innate immune responses and contributes to urothelial hyperplasia by regulating urothelial differentiation in obstructive kidney injury.

Clinical Significance of Smudge Cells in Peripheral Blood Smears in Hematological Malignancies and Other Diseases

Chang, Chih-Chun,Sun, Jen-Tang,Liou, Tse-Hsuan,Kuo, Chin-Fu,Bei, Chia-Hao,Lin, Sheng-Jun,Tsai, Wei-Ting,Tan, N-Chi,Liou, Ching-Biau,Su, Ming-Jang,Yen, Tzung-Hai,Chu, Fang-Yeh Asian Pacific Journal of Cancer Prevention 2016 Asian Pacific journal of cancer prevention Vol.17 No.4

Background: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear. Hence, this study was conducted to survey the clinical significance of smudge cells in hematological cancers and other disorders. Materials and Methods: From January to November, 2015, the clinical data of patients who received blood examination with differential counts for clinical purpose and were found to have smudge cells in the peripheral blood film in Far Eastern Memorial Hospital were selected. The percentage of smudge cells and patient outcomes were evaluated for further univariate and survival analyses. Results: A total of 102 patients with smudge cells in their blood smears were included. Smudge cells were frequently presented in out-of-hospital cardiac arrest (OHCA; n=30), infections (n=23), hematological cancers (n=23) and solid cancers (n=10). There was no relationship between the percentage of smudge cells and the patient mortality in all diseases (OR: 1.08, 95% CI: 0.47-2.48, P=1.000) as well as the OHCA group (OR: 1.91, 95% CI: 0.38-9.60, P=0.694). It was observed that in patients with all cancers with the percentage of smudge cells less than 50% had a lower mortality rate in comparison with those who had the percentage of smudge cells of 50% or more (OR: 22.29, 95% CI: 2.38-208.80, P<0.001). Additionally, it was seemingly that patients with smudge cells of 50% or more had a lower survival rate than those with smudge cells less than 50% in all cancers with follow-up at 2-month intervals, but without statistical significance (P=0.064). Conclusions: Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most study populations was non-Asian; hence, further investigations are required. Besides, there was no apparent association of the percentage of smudge cells with patient outcomes in all diseases, including OHCA.

A stiffness adjustable magneto-elastic actuation utilizing axial couplings

Li-Wei Cheng,Jen-Yuan Chang 대한기계학회 2023 JOURNAL OF MECHANICAL SCIENCE AND TECHNOLOGY Vol.37 No.8

An adjustable torsional stiffness control system with a magnetic coupling that offers compliance for robotic devices to cooperate with humans is presented in this paper. Most robotic devices, such as robotic grippers or robotic arms, achieve torque control by manipulating current in actuators. As power consumption derived from the actuator current is not precise enough to represent the output torque, series elastic actuation (SEA) is instead proposed and examined in this research that involves adding an elastic component between the actuator and the load, allowing the force to be measured by calculating the deformation of this elastic component. In this paper, an axial magnetic coupling having 24 mm in diameter and 3 mm in thickness forming is adopted as the elastic component of the magnetic series elastic actuation (MSEA) system. Through the MSEA controller, the load stiffness can be controlled as a variable spring in a range of 100 to 500 mN·m/rad, producing a maximum output torque of 300 mN·m, force resolution of 0.1 mN·m and control error less than 6 mN·m. By adding the SEA component between the actuator and the load, one can control system’s output torque and output stiffness simultaneously, making the actuator more flexible and compliant.

Risk factors in progression from endometriosis to ovarian cancer: a cohort study based on medical insurance data

An Jen Chiang,Chung Chang,Chi-Hsiang Huang,Wei-Chun Huang,,Yuen-Yee Kan,Jiabin Chen 대한부인종양학회 2018 Journal of Gynecologic Oncology Vol.29 No.3

Objective: The objective was to identify risk factors that were associated with the progression from endometriosis to ovarian cancer based on medical insurance data. Methods: The study was performed on a dataset obtained from the National Health Insurance Research Database, which covered all the inpatient claim data from 2000 to 2013 in Taiwan. The International Classification of Diseases (ICD) code 617 was used to screen the dataset for the patients who were admitted to hospital due to endometriosis. They were then tracked for subsequent diagnosis of ovarian cancer, and available biological, socioeconomic and clinical information was also collected. Univariate and multivariate analyses were then performed based on the Cox regression model to identify risk factors. C-index was calculated and cross validated. Results: A total of 229,617 patients who were admitted to hospital due to endometriosis from 2000 to 2013 were included in the study, out of whom 1,473 developed ovarian cancer by the end of 2013. A variety of factors, including age, residence, hospital stratification, premium range, and various comorbidities had significant impact on the progression (p<0.05). Among them, age, urbanization of residence, hospital stratification, premium range, post-endometriosis childbearing, pelvic inflammation, and depression all had independent, significant impact (p<0.05). The validated C-index was 0.69. Conclusion: For a woman diagnosed with endometriosis, increased age, residing in a highly urbanized area, low or high income, depression, pelvic inflammation, and absence of childbearing post-endometriosis all put her at high-risk to develop ovarian cancer. The findings may be of help to gynecologists to identify high-risk patients.

Enhanced x-ray irradiation-induced cancer cell damage by gold nanoparticles treated by a new synthesis method of polyethylene glycol modification

Liu, Chi-Jen,Wang, Chang-Hai,Chien, Chia-Chi,Yang, Tsung-Yeh,Chen, Shin-Tai,Leng, Wei-Hua,Lee, Cheng-Feng,Lee, Kuen-Ho,Hwu, Y,Lee, Yao-Chang,Cheng, Chia-Liang,Yang, Chung-Shi,Chen, Y J,Je, J H,Margari IOP Pub 2008 Nanotechnology Vol.19 No.29

<P>We explored a very interesting gold nanoparticle system—pegylated gold in colloidal solution—and analyzed its uptake by mice colorectal adenocarcinoma CT26 tumor cells and the impact on the cell’s response to x-ray irradiation. We found that exposure to polyethylene glycol (PEG) modified (‘pegylated’) 4.7 ± 2.6 nm gold nanoparticles synthesized by a novel synchrotron-based method enhances the response of CT26 cells to x-ray irradiation. Transmission electron microscopy (TEM) and confocal microscopy revealed that substantial amounts of such nanoparticles are taken up and absorbed by the cells and this conclusion is supported by quantitative induced coupled plasma (ICP) results. Standard tests indicated that the internalized particles are highly biocompatible but strongly enhance the cell damage induced by x-ray irradiation. Synchrotron radiation Fourier transform infrared (SR-FTIR) spectromicroscopy analyzed the chemical aspects of this phenomenon: the appearance of C = O stretching bond spectral features could be used as a marker for cell damage and confirmed the enhancement of the radiation-induced toxicity for cells.</P>

The development of Taiwan Fracture Liaison Service network

Lo-Yu Chang,Keh-Sung Tsai,Jen-Kuei Peng,Chung-Hwan Chen,Gau-Tyan Lin,Chin-Hsueh Lin,Shih-Te Tu,I-Chieh Mao,Yih-Lan Gau,Hsusan-Chih Liu,Chi-Chien Niu,Min-Hong Hsieh,Jui-Teng Chien,Wei-Chieh Hung,Rong-S 대한골다공증학회 2018 Osteoporosis and Sarcopenia Vol.4 No.2

Osteoporosis and its associated fragility fractures are becoming a severe burden in the healthcare system globally. In the Asian-Pacific (AP) region, the rapidly increasing in aging population is the main reason accounting for the burden. Moreover, the paucity of quality care for osteoporosis continues to be an ongoing challenge. The Fracture Liaison Service (FLS) is a program promoted by International Osteoporosis Foundation (IOF) with a goal to improve quality of postfracture care and prevention of secondary fractures. In this review article, we would like to introduce the Taiwan FLS network. The first 2 programs were initiated in 2014 at the National Taiwan University Hospital and its affiliated Bei-Hu branch. Since then, the Taiwan FLS program has continued to grow exponentially. Through FLS workshops promoted by the Taiwanese Osteoporosis Association (TOA), program mentors have been able to share their valuable knowledge and clinical experience in order to promote establishments of additional programs. With 22 FLS sites including 11 successfully accredited on the best practice map, Taiwan remains as one of the highest FLS coverage countries in the AP region, and was also granted the IOF Best Secondary Fracture Prevention Promotion award in 2017. Despite challenges faced by the TOA, we strive to promote more FLS sites in Taiwan with a main goal of ameliorating further health burden in managing osteoporotic patients.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

( Shu-Chen Wei ),( Ting-An Chang ),( Te-Hsin Chao ),( Jinn-Shiun Chen ),( Jen-Wei Chou ),( Yenn-Hwei Chou ),( Chiao-Hsiung Chuang ),( Wen-Hung Hsu ),( Tien-Yu Huang ),( Tzu-Chi Hsu ),( Chun-Chi Lin ) 대한장연구학회 2017 Intestinal Research Vol.15 No.3

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan. (Intest Res 2017;15:266-284)

Management of Crohn`s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

( Shu-Chen Wei ),( Ting-An Chang ),( Te-Hsin Chao ),( Jinn-Shiun Chen ),( Jen-Wei Chou ),( Yenn-Hwei Chou ),( Chiao-Hsiung Chuang ),( Wen-Hung Hsu ),( Tien-Yu Huang ),( Tzu-Chi Hsu ),( Chun-Chi Lin ) 대한장연구학회 2017 Intestinal Research Vol.15 No.3

Crohn`s disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan. (Intest Res 2017;15:285-310)